Abstract：
OBJECTIVE: Thyroid nodules are a common incidental imaging finding and prone to overdiagnosis. Several risk stratification systems have been developed to reduce unnecessary work-up, with two of the most utilized including the American Thyroid Association 2015 (ATA2015) and the newer American College of Radiology Thyroid Imaging, Reporting and Data System (TIRADS) guidelines. The purpose of this study is to evaluate the cost-effectiveness of the ATA2015 versus the TIRADS guidelines in the management of incidental thyroid nodules.
METHODS: A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5% per annum were utilized. Scenario, deterministic and probabilistic sensitivity analyses were performed. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per quality-adjusted life year (QALY) gained.
RESULTS: For the base case scenario, TIRADS dominated the ATA2015 strategy by a slim margin, producing 0.005 more QALYs at $25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time.
CONCLUSIONS: The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules.
METHODS: A cost-utility analysis was conducted using decision tree modeling, evaluating adult patients with incidental thyroid nodules < 4 cm. Model inputs were populated using published literature, observational data, and expert opinion. Single-payer perspective, Canadian dollar currency, five-year time horizon, willingness to pay (WTP) threshold of $50,000, and discount rate of 1.5% per annum were utilized. Scenario, deterministic and probabilistic sensitivity analyses were performed. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as incremental cost per quality-adjusted life year (QALY) gained.
RESULTS: For the base case scenario, TIRADS dominated the ATA2015 strategy by a slim margin, producing 0.005 more QALYs at $25 less cost. Results were sensitive to the malignancy rate of biopsy and the utilities of a patient with a benign nodule/subclinical malignancy or under surveillance. Probabilistic sensitivity analysis showed that TIRADS was the more cost-effective option 79.7% of the time.
CONCLUSIONS: The TIRADS guidelines may be the more cost-effective strategy by a small margin compared to ATA2015 in most scenarios when used to risk stratify incidental thyroid nodules.
摘要：
目的：甲状腺结节是一种常见的偶然影像学表现，容易过度诊断。已经开发了几种风险分层系统来减少不必要的工作，其中两个使用最多的包括2015年美国甲状腺协会（ATA2015）和较新的美国放射学甲状腺成像学院，报告和数据系统（TIRADS）指南。这项研究的目的是评估ATA2015与TIRADS指南在偶然甲状腺结节管理中的成本效益。
方法：使用决策树建模进行了成本效用分析，评估甲状腺偶发结节<4cm的成人患者。使用已发布的文献填充模型输入，观测数据，和专家意见。单一付款人视角，加拿大元货币,五年的时间范围，支付意愿(WTP)门槛为50,000美元，贴现率为每年1.5%。Scenario,进行了确定性和概率敏感性分析.主要结果是增量成本效益比（ICER），表示为获得的每质量调整生命年（QALY）的增量成本。
结果：对于基本情况，TIRADS以微弱优势主导了ATA2015战略，以25美元的成本生产0.005个以上的QALY。结果对活检的恶性率以及患有良性结节/亚临床恶性肿瘤或在监视下的患者的效用敏感。概率敏感性分析显示，在79.7%的情况下，TIRADS是更具成本效益的选择。
结论：与ATA2015相比，在大多数情况下，TIRADS指南可能是更具成本效益的策略，用于对偶然的甲状腺结节进行风险分层。
方法：使用决策树建模进行了成本效用分析，评估甲状腺偶发结节<4cm的成人患者。使用已发布的文献填充模型输入，观测数据，和专家意见。单一付款人视角，加拿大元货币,五年的时间范围，支付意愿(WTP)门槛为50,000美元，贴现率为每年1.5%。Scenario,进行了确定性和概率敏感性分析.主要结果是增量成本效益比（ICER），表示为获得的每质量调整生命年（QALY）的增量成本。
结果：对于基本情况，TIRADS以微弱优势主导了ATA2015战略，以25美元的成本生产0.005个以上的QALY。结果对活检的恶性率以及患有良性结节/亚临床恶性肿瘤或在监视下的患者的效用敏感。概率敏感性分析显示，在79.7%的情况下，TIRADS是更具成本效益的选择。
结论：与ATA2015相比，在大多数情况下，TIRADS指南可能是更具成本效益的策略，用于对偶然的甲状腺结节进行风险分层。
